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[Mim]

May I ask if people have used utrogestan vaginally successfully for more than 5 years. I read that after 5 years absorption may be unreliable. I am not sure why this would be.

[Hurdity]

Hi Mim

I've been using it vaginally, successfully for 10 years. I have never come across that information at all - and I can think of no biological reason why it would be the case either.

However the mention of 5 years is in relation to sequential use of utrogestan - not to do with absorption but because cyclical HRT may not protect the endometrium adequately beyond 5 years according to the research - and quite possibly because there is inadequate research. So not to do with absoprtion per se but I would suggest a potential cumulative effect of inadequate protection. This of course will depend both on the dose of oestrogen and the mode of delivery and dose/duration of Utrogestan as well as the woman's body - how it responds.

The British Menopause Society paper on progestogens and endometrial protection https://thebms.org.uk/wp-content/uploads/2022/12/15-BMS-TfC-HRT-preparations-and-equivalent-alternatives-NOV2022-A.pdf   

Here is an extract of the summary:

"Non-hysterectomised women require progestogen administered for 12–14 days in a sequential
regimen and daily in a continuous combined regimen to minimise the risk of endometrial hyperplasia
and endometrial cancer associated with unopposed estrogen exposure.
• Long-term use of sequential combined HRT for >5 years may be associated with a small increase
in risk of endometrial hyperplasia and endometrial cancer, with the risk being dose and duration
dependent in relation to progestogen intake.
• Studies suggest that women taking sequential HRT with less than 10 days of progestogen each
month are at increased risk of endometrial hyperplasia and endometrial cancer.
• However, progestogen intake in the recommended doses for 12-14 days a month does not appear to
be associated with a significant increase in risk of endometrial hyperplasia for up to 5 years of use.
• Systematic review evidence showed oral micronised progesterone provides endometrial protection
if applied sequentially for 12–14 days/month in a dose of 200mg/day for up to five years.
• The dose of the progestogen should be proportionate to the dose of estrogen. Women who require
high dose estrogen intake should consider having their progestogen dose increased to ensure
adequate endometrial protection."

Generally the paper is saying that there is are insufficient data on vaginal use but that when used vaginally the BMS recommends that doses should be the same as oral use.

As always - any abnormal bleeding should be investigated by the GP in the first instance

Hope this helps

Hurdity x

[Mim]

Thank you Hurdity, for your detailed reply.
So does sequential HRT for more than 5 years increase the risk of endometrial  hyperplasia / carcinoma full stop? Regardless of whether systemic progesterone or progestogens are used or is it simply that the data does not exist for micronised progesterones.

If the latter it’s frustrating that the studies have not been done as it has been used in HRT regimes in mainland Europe for many years.

[sheila99]

I was told that too but I'm not convinced there's good evidence to either prove or disprove it. I was also told by a specialist I couldn't possibly still have my own cycle at 57 because everyone is meno by 54 (do I have to show you the evidence?...). It's about 3 years since I looked but then evidence was sadly lacking.